An observational, stepped-wedge evaluation of an intervention designed by the NGO Companeros en Salud (CES) in Chiapas, Mexico found that CHWs providing outreach in communities improved disease control and medication adherence for patients with diabetes and/or hypertension.1 The evidence for CHW contribution to non-communicable diseases (NCDs) in LMIC is limited, and this intervention – initiated in 2014 – provided an opportunity for a robust evaluation. The intervention, “Acompanantes’, trained CHWs who were nominated during community meetings to provide basic diagnosis and treatment for diabetes and hypertension during home visits. These CHWs worked with four to eight patients each, visiting their homes regularly, accompanying them to clinic visits, and discussing their care management with providers. CHWs received compensation in the form of food and consumable items. The intervention was associated with an 86% increased odds of optimal adherence and twofold increase in positive adherence behavior in community members who received the intervention compared to those who did not receive the intervention.  It is important to note that in this intervention and following the “community-based accompaniment” approach, CHWs’ roles are intended to improve access to existing care rather than fill gaps or task-shift responsibilities. Therefore, strategies such as this one are most effective if they are added to an already functional primary health care system. In health systems with substantial gaps in the delivery of comprehensive primary health care at facilities, proactive outreach may not be the most effective initial intervention.

References:

  1. Newman PM, Franke MF, Arrieta J, Carrasco H, Elliott P, Flores H, et al. Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. BMJ Glob Health. 2018 Feb 15;3(1):e000566.